| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,008 |
1,921 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
1,761 |
1,681 |
$811.52 |
| D1206 |
Topical application of fluoride varnish |
2,313 |
2,201 |
$714.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,975 |
1,393 |
$412.40 |
| D0220 |
Intraoral - periapical first radiographic image |
1,603 |
1,486 |
$380.89 |
| D0272 |
Bitewings - two radiographic images |
620 |
572 |
$224.08 |
| D1351 |
Sealant - per tooth |
127 |
31 |
$84.00 |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
55 |
$47.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
242 |
224 |
$33.48 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
309 |
$28.00 |
| D0330 |
Panoramic radiographic image |
73 |
67 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
124 |
116 |
$0.00 |
| D1110 |
Prophylaxis - adult |
82 |
75 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
15 |
$0.00 |
| D1330 |
|
2,404 |
2,222 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
74 |
$0.00 |